Myoepithelioma: Definitions and Diagnostic Criteria

Due to their infrequency and multiplicity of histopathology, myoepitheliomas present difficulties in diagnosis and classification. Cellular varieties can be misdiagnosed as malignancies. Improvements in and clarification of diagnostic criteria are, therefore, required. A key to determining diagnostic criteria for myoepitheliomas is to study cellular morphology, cytoplasmic filament expression, and ultrastructural features of the nonluminal, i.e., neoplastic myoepithelial/basal, tumor cells of pleomorphic adenomas, and apply this information to defining myoepitheliomas. Cytologic and growth patterns of nonluminal cells in pleomorphic adenomas, including plasmacytoid cells, are reflected in myoepitheliomas. Results also indicate that muscle-specific actin and myofilaments are expressed only in a proportion of cases, and generally in not more than 60-70% of nonluminal cells in pleomorphic adenoma; this also applies to benign and malignant myoepitheliomas. The absence of these markers does not exclude a diagnosis of myoepithelioma. Vimentin and glial acidic fibrillary protein, however, are strongly and diffusely expressed in the majority of pleomorphic adenomas and myoepitheliomas and are more reliable markers for these tumors than muscle-specific actin. Like so many other salivary gland tumors, myoepitheliomas present an equally complex histomorphology and variable expression of antigenic markers, only some of which are associated with myoepithelial and basal cells of the acini and ducts of the normal salivary gland.     

Diagnostic Criteria of Post-Traumatic Stress Disorders

The origination of the diagnosis “post-traumatic stress disorder” (PTSD) is discussed in relation to its historical and diagnostic aspects. The different criteria for PTSD are analyzed in accordance with the ICD-10 and DSM (from DSM-III to DSM-IV-TR) systems. Attention is drawn to the diagnostic concept “acute stress disorder” (ASD) and its place in the dynamics of PTSD: ASD, acute PTSD, chronic PTSD. Supporting the view that PTSD exists as an individual nosological entity, the authors note significant differences in the clinical analysis of the psychopathological phenomena making up PTSD by different authors.     

Somatization and depression

The majority of depressed patients complaining of physical symptoms first present to general practitioners. This article reviews the frequency of association between somatization and depression and the links between them. The need to prevent persistent somatization is emphasized.     

Comparison of Diagnostic Criteria and Determination of Prognostic Factors for Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome

Purpose

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is characterized by prolonged clinical symptoms even after the withdrawal of the culprit drug. Different criteria to diagnose DRESS syndrome have been proposed; however, there have been limited studies on prognostic factors. We investigated appropriate criteria for the diagnosis of DRESS syndrome in practice and with associated prognostic factors.

Methods

A total of 48 patients with DRESS syndrome that satisfied RegiSCAR possible (or more) criteria were retrospectively recruited. They were also analyzed according to Bocquet''s criteria and Japanese drug-induced hypersensitivity syndrome (DIHS) criteria. The duration of clinical manifestations, requirement for steroids, and fatalities determined the severity of DRESS syndrome. Blood tests were performed at initial presentation to our hospital.

Results

A total of 60.4% of patients satisfied RegiSCAR definite criteria and 77.1% satisfied Bocquet''s criteria. Only 18.8% satisfied atypical DIHS criteria from the Japanese group. A total of 96.6% patients who fit the RegiSCAR definite criteria, 96.6% also satisfied Bocquet''s criteria; reciprocally, 75.7% of patients who met Bocquet''s criteria also satisfied RegiSCAR definite criteria. The duration of clinical symptoms positively correlated with leukocyte, lymphocyte, and eosinophil counts in non-fatal cases. Lymphocyte counts were higher in patients who used steroids compared to steroid-naïve patients. Fatal cases showed higher serum creatinine and ferritin levels compared to non-fatal cases.

Conclusions

Bocquet''s criteria is efficient and appropriate to diagnose DRESS syndrome in clinical practice. Lymphocyte and eosinophil counts as well as creatinine and ferritin levels could be useful early prognostic factors.     

"病理性上网"诊断标准的初步制订

目的:初步制订"病理性上网"的诊断标准,为全国测查及完善该标准提供依据.方法:检索文献中常用的与"病理性上网"有关的 "诊断标准"或筛选标准,据此建立"病理性上网"的诊断标准条目库及初步诊断标准.测查中,由每两名具有高级职称的精神科医生(共8名)组成一组,根据"病理性上网"操作性定义,以本文制定的初步诊断标准为检查提纲,交替对79名因上网问题住院的受试者及其家属进行访谈,独立评定并作出诊断.另外,方便选取某高中一年级2个班的全体男生,共44人,由评定者单独访谈、评定.两名评定者均作出诊断时方可确诊,否则排除诊断.结果:123名受试者中"病理性上网"者为54名.两名专家的诊断一致性Kappa=0.812(P<0.001).条目库中12条症状有2条评定者间一致性差,4条对诊断贡献小.在保留的6个条目中,4条以上阳性时,诊断的灵敏度为78.9%,特异度为95.3%.严重程度标准偏严格.确定诊断者的病程90.7%为3个月以上,77.7%为6个月以上.结论:修订后的初步诊断标准包括6项症状标准,3项严重程度标准,1项病程标准,以及排除标准.本标准评定者间一致性高、可操作性强,可作为下一步制定"病理性上网"操作性诊断标准的基础.     

Diagnostic Criteria for Human Diffuse M a lignant Mesothelioma

Diffuse malignant mesothelioma is a rare tumor in the general population, yet is unique in that it is caused almost exclusively by exposure to asbestos with long-term latency (15 years and over). Pathologists are required to provide a reliable diagnosis of the tumor for clinicians who are responsible for the treatment of affected patients. Pathological diagnosis of diffuse malignant mesothelioma is not always easy; however, it has improved over the last few decades. Currently, comprehensive analysis, including gross appearance, histology, histochemistry, immunocyto-chemistry and electron microscopy is recommended as the best approach to an accurate diagnosis of diffuse malignant mesothelioma. Acta Pathol Jpn 42: 767–786, 1992.     

ICD-10进食障碍分类和诊断标准在中国应用的几点修改建议

进食障碍(eating disorders,ED)是以进食行为异常为显著特征的一组综合征,主要包括神经性厌食和神经性贪食两大类,是主要发生于青少年和成年早期女性的心身疾病,患病率为 1%～4.2%,在美国、日本、西班牙、中国香港等地开展的研究显示,随着社会经济的发展,进食障碍的患病率呈增加的趋势[1].因此进食障碍的标准化诊断,就显得尤为重要.     

乳腺超声检查中BI-RADS分级诊断标准对乳腺原位癌的诊断价值

目的 探究应用BI-RADS分级诊断标准来诊断乳腺原位癌的超声诊断价值,以提升超声工作者对规范乳腺诊断标准认识和运用,提高彩色多普勒超声对乳腺原位癌的诊断能力。方法 选取2015年5月~2018年5月在我院通过手术及病理结果证实为乳腺原位癌的患者37例,系统回顾了根据病灶所显示出的不同声像图特征,综合分析采用BI-RADS超声分级诊断,探讨误诊主要原因。结果 37例乳腺原位癌病例中,超声诊断准确率为75.36%（28/37）,4例未定,5例误诊,其中1例误诊为导管内乳头状瘤,1例误诊为导管浸润癌,1例误诊为导管局部扩张,2例误诊为瘤样增生。结论 彩色多普勒超声诊断仪采用BI-RADS分级诊断方法,较大提高了乳腺原位癌的检出率,联合其它辅助检查可明显提高检出率,在指导临床对患者乳腺疾病的评估起到重要作用。     

Clinical Approaches to Somatization

Somatization is the experience and expression of psychological distress through bodily symptoms. Somatization can be conceptualized as an emotional state that has not been represented symbolically or as a defense against intolerable emotions and fantasies. Bodily concerns can also function as a means of seeking responsiveness from others. Alexithymia refers to a difficulty identifying and symbolizing emotional states that has been found to be associated with somatization. When functioning as a defense, a focus on the body can be used to avoid frightening or intolerable feelings and fantasies, or to ward off aggressive fantasies by viewing oneself as physically damaged. Systematic studies have demonstrated the presence of the defense of somatization in mood disorders, particularly anxiety and panic disorders. In treating anxiety disorders, the therapist helps the patient to determine the nature of emotions and fantasies that the patient is defending against, particularly fears and conflicts surrounding anger and separation.     

自恋型人格障碍诊断标准的演进与问题

本文在回顾了自恋型人格障碍的诊断标准在DSM诊断系统中的演变过程后，分别从共病、维度、文化差异三个方面讨论了时下对这一诊断标准存在的较多争议，并在此基础上做了些展望。以期对DSM中自恋型人格障碍诊断标准有更全面的了解。     

维和军人躯体化症状:中国与巴基斯坦军人之表现与影响因素

目的研究承担维和任务的中国和巴基斯坦军人的心身健康。方法对执行维和任务的中国军人79人和巴基斯坦66人,进行一般资料、症状自评量表(SCL-90)和艾森克人格问卷(EPQ)调查,对躯体化症状与影响因素进行相关性分析。结果中国军人躯体化阳性症状的发生率是16.4%,巴基斯坦军人的发生率是15.2%;中国军人主要表现为失眠、恶心、胃部不适,巴基斯坦军人主要表现为恶心、胃部不适,失眠、腰痛;躯体化阳性与内外向E、神经质N有明显的正相关性;年龄对躯体化阳性的影响中国军人(r=0.99),巴基斯坦军人(r=0.83);受文化教育,父母的教育方式均影响个人自评阳性因子分,中国军人r=0.05,0.08(P<0.05),巴基斯坦军人r=0.07,0.10(P<0.05)。结论负性情绪、人格特征是产生躯体化症状的易感性与维持性因素,提高心理柔韧性对于保障维和军人的心身健康有积极意义。     

Why the Diagnostic Criteria for Dissociative Identity Disorder Should Be Changed

Abstract

This paper examines the psy chi at ricdiagnosis of dissociative identity disorder (DID)inlightofthedevelopmentsinpsychi at ricclassification that have guided the last four re vi sions of the Diagnostic and Sta tis ti calMan ualforMen talDis or ders (DSM) (Amer i can Psychiatric Association, 1980, 1987, 1994, 2000). The author argues that multiple per son al ity 's pas sage from DSM-III, through DSM-III-R, to its current form as DID in DSM-IV-TR has left the di ag no sis out of step with the state of the art of psy chi atric classification. Ten dis advantages of the Diagnostic and Sta tis ti calMan ual of Men talDis or ders, Fourth Edi tion- Text Revision (DSM-IV-TR) cri te riafor DID are iden ti fied. The DSM-IV-TR cri te ria for DID: (1) are out of step with the state of the art of psy chi at ric clas si fi cation; (2) are not based on taxometric anal y sis of the symp toms of DID; (3) in correctly im ply that DID is a closed con cept; (4) have poor con tent valid ity; (5) throw away im portantinformation; (6) dis courage taxonomic research; (7) have poor reliability and cause frequent misdiagnoses; (8) are not “user-friendly”; (9) are un nee es sar ily con tro versial; and (10) along with pre vi ous ver sions of the DSM, have pro duced an artifactually low base-rate of DID for the past 20 years. In an effort to remedy these disadvantages, a re liable, user-friendly, polythetic set of diagnostic criteria for “Major Dissociative Disorder” is proposed for DSM-V. Using these polythetic cri te ria, the dissociative dis or ders (presently con cep tu al ized as Dissociative Am ne sia, Dissociative Fugue, DID, Depersonalization Disorder, and Dissociative Disorder Not Otherwise Spec ified) can be re struc tured into an eas ily un der stood and more re liable set of di ag nos tic en ti ties. This al ter nate nosology of the dissociative disorders consists of Sim pie Dissociative Dis or der (with at least three). sub types), Gen er al ized Dissociative Dis or der, Major Dissociative Disorder (with two subtypes), and Dissociative Disorder Not Otherwise Specified.     

躯体化障碍与童年期的创伤

目的：探讨童年创伤与躯体化障碍形成的关系。方法：对象为一躯体化障碍女性患者，通过治疗性晤谈，收集其病史、阻抗、移植和反移植等材料，使用内省的、通情的和精神分析的 方法进行分析。结果：患者童年期有严重的创伤经历，其特征是丧母及长期的过度劳累性身体虐待，相应的表现有严重的压抑、分离、惊恐发作和生理应激反应。成年后突出的病征是躯体化障碍和惊恐发作，其发生和加重与分离和劳累联系在一起。这些情境类似于童年期的创伤情境，症状表现也类似过去的，提示其躯体化障碍是过去创伤性反应的再次唤起。结论：躯体化障碍可能起源于童年期不可逃避的持续性身体虐待所导致的生理应激反应。症状的形成机制涉及情绪的压抑、躯体反应的分离、继发性获益以及受虐性的客体关系内化，而后者导致对创伤主动的追寻倾向。